The Louisiana Department of Insurance (LDI) issued Directive 257 on Feb. 13, 2026, which instructs pharmacy benefit managers (PBMs) to adopt a specific reimbursement methodology for all local/independent pharmacies in the state. This methodology is a significant increase above current pricing used by Express Scripts*, our PBM, and will lead to increased costs for employer plan sponsors and Blue Cross and Blue Shield of Louisiana (Louisiana Blue) members. Directive 257 applies to fully insured and self-insured plans, including ERISA plans.

Implementing Directive 257 will affect Louisiana Blue members in their pocketbooks at local/independent pharmacies because the pricing methodology increases out-of-pocket costs immediately. For lower-cost drugs, members will shoulder much of the financial burden at the pharmacy counter. For higher-cost drugs, plan sponsors will absorb the higher costs, driving up premiums.

Example of increased costs under Directive 257:

• If you fill a drug monthly (30-day supply) to control a chronic problem such as high blood pressure or high cholesterol at a local/independent pharmacy, and your drug’s total drug cost is about $7.37 today, the total cost of your drug could be $15 or more per fill as of March 1.

Louisiana Blue continues to review Directive 257 and the potential financial impact on our members and employer customers across the state. We will share more information about what our customers can expect from these changes as needed.

Background

In 2025, Louisiana legislators passed Act 474 to be effective Jan. 1, 2026. Act 474 applies to PBMs and how they reimburse local/independent pharmacies for the drugs they dispense to customers. Local/independent pharmacies do not include national chains. Here are some key points:

1. Act 474 requires PBMs to follow a specific formula to reimburse local pharmacies for prescriptions they fill. PBMs must now pay pharmacies based on a national benchmark pricing list + an adjustment factor + a professional dispensing fee. The law did not specify any adjustment factor or professional dispensing fee amounts.
2. In December, the LDI issued an Advisory Letter stating the national benchmark pricing list should be NADAC (National Average Drug Acquisition Cost) and that the formula should include a 2% adjustment factor and a professional dispensing fee that cannot be $0 or nominal.
3. Earlier this month, the LDI issued Directive 257. The Directive orders PBMs to use the NADAC price list and add $9 per 30-day prescription filled at local pharmacies. The Directive requires PBMs to be in compliance by March 1, 2026.

Louisiana Blue believes that local/independent pharmacies serve an important role in providing access to prescription drugs. However, our highest priority will always be our Louisiana Blue members and employer group customers, and our continuous effort to contain the cost of healthcare while improving the health and lives of Louisianians.

*Express Scripts, Evernorth's pharmacy benefit services business, is an independent company that manages prescription benefits for Blue Cross and Blue Shield of Louisiana and HMO Louisiana, Inc.